Stressed and Depressed, South Koreans Avoid Therapy

Mark McDonald|The New York Times

Friday, 8 Jul 2011 | 3:06 AM ETThe New York Times

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It can sometimes feel as if South Korea, overworked, overstressed and ever anxious, is on the verge of a national nervous breakdown, with a rising divorce rate, students who feel suffocated by academic pressures, a suicide rate among the highest in the world and a macho corporate culture that still encourages blackout drinking sessions after work.

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More than 30 South Koreans kill themselves every day, and the suicides of entertainers, politicians, athletes and business leaders have become almost commonplace. The recent suicides of four students and a professor at Korea’s leading university shocked the nation, and in recent weeks a TV baseball announcer, two professional soccer players, a university president and the former lead singer in a popular boy band killed themselves.

And yet Koreans — while almost obsessively embracing Western innovations ranging from smartphones to the Internet to cosmetic surgery — have largely resisted Western psychotherapy for their growing anxieties, depression and stress. Talk-therapy modalities with psychiatrists, psychologists and other types of trained counselors are only slowly being accepted, according to mental health experts here.

“Talking openly about emotional problems is still taboo,” said Dr. Kim Hyong-soo, a psychologist and professor at Chosun University in Kwangju.

“With depression, the inclination for Koreans is to just bear with it and get over it,” he said. “If someone goes to a psychoanalyst, they know they’ll be stigmatized for the rest of their life. So they don’t go.”

Mental health experts said many troubled South Koreans seek help from private psychiatric clinics (and pay their bills in cash) so their government-insurance records do not carry the stigma of a “Code F,” signifying someone who has received reimbursement for such care.

Even when Koreans do seek out counseling, the learning curve can be steep.

A prominent psychiatrist with a practice in Seoul, Jin-seng Park, said it was not uncommon for some new patients to come to his office, talk over a problem for 40 minutes and then be shocked when they’re presented with a bill.

“They’ll say, ‘I have to pay? Just for talking? I can do that for free with my friend or my pastor,”’ said Dr. Park.

Patients also balk, he said, at the idea of spending more than a couple sessions on talk therapy. Instead, most patients simply ask for, and expect, medication, said Dr. Park, whose Web site advises that “nearly all of the medications used in the U.S. are available here, too. So don’t worry about getting those medications in Korea.”

About a third of his patients come for counseling, Dr. Park said, and the rest rely on medication.

“Koreans are getting more comfortable with Western psychotherapy, but this is limited to the highly educated and those familiar with Western ways,” said Dr. Oh Kyung-ja, a Harvard-trained professor of clinical psychology at Yonsei University in Seoul.

Meanwhile, the suicide rate in South Korea is nothing short of alarming, nearly three times higher than in the United States. The rate here doubled in the decade between 1999 and 2009. Suicide pacts among strangers who meet online is a growing phenomenon. Suicides by drinking pesticides, hanging or jumping from tall buildings are the most common.

“We have seen a rapid increase in depression, and I’d say 80 to 90 percent of our suicides are byproducts of depression,” said Dr. Kim. Government mental health clinics have proved effective in helping with basic family or marital problems, he said, “but they’re not getting at depression.”

“That issue is still very closed. We still conceal it.”

South Korean society has traditionally been underpinned by Buddhist and Confucian values, which emphasize diligence, stoicism and modesty. Individual concerns are secondary. Preserving dignity, or “face,” especially for the family, is paramount.

Some experts trace South Korea’s emotional malaise to the decline of these traditional values and the rise of the country as a modern industrial power, starting in the 1980s. South Korea, once even poorer than woeful North Korea, now boasts the world’s 13th-largest economy.

“As the society became more oriented toward materialism, people started to compare themselves,” said Dr. Park. “There’s a lot of competition now, even starting in childhood, and the goals of life have moved. We have a saying, ‘If one cousin buys land, the other cousin gets a stomachache.”’

With Confucian values on the wane, Koreans use a variety of ways — short of prescribed medications — to wick off the stresses of the hectic pace of urban life. Consulting shamans, outdoor exercise like golf and hiking, alcohol, organized religion, the Internet and travel are common outlets now.

Christian pastoral counseling can be a support for some patients, said Dr. Park, who has tutored ministers on therapeutic techniques, although he cautioned that this was no substitute for professional therapy. “Pastors try to treat patients themselves,” he said, “and this can have serious and dangerous complications, even deaths.”

Consulting a shaman is still common among many Koreans, usually when they come down with the blues, the odd illness or a run of bad luck. Indeed, shamanism has made something of a comeback in South Korea in recent years, with an estimated 300,000 shamans ministering to clients.

Many shamans, known as mudang, even operate sophisticated Web sites these days (complete with online fortune telling), even as they continue to strangle chickens, walk barefoot on razor blades and commune with dead relatives whose spirits reside in trees, chimneys or woodland creatures.

“More Koreans see fortunetellers than psychiatrists,” said Dr. Yoon Dae-hyun, a psychiatrist at Seoul National University Hospital and an official with the Korean Association for Suicide Prevention. “Our biggest competitors are fortunetellers and room salons. They certainly make more money than us.”

Room salons are after-work clubs frequented by hard-drinking businessmen who select from a bevy of personal hostesses who ply them with expensive drinks and listen to their problems over the course of an evening.

Yu Jeong is a fortuneteller at Daily Motion, a cafe in Seoul that features 15-minute readings (and a free waffle) with the purchase of a coffee.

“Psychiatrists treat patients like patients, so the people don’t tell them every bad thing,” she said. “Young people come in here and tell me everything, even the things they won’t tell their parents.”

Young people in South Korea are certainly unhappy, even chronically so, in part because of ferocious academic pressures that begin early on. A recent survey here found that young Koreans — for the third straight year — were the unhappiest youngsters in a subset of Organization for Economic Cooperation and Development countries.

Ms. Yu said she counsels about 50 people a day, usually couples or small groups of friends who are seeking advice on romance, marriage or changing jobs.

“Koreans are trying to find their own ‘package,’ their own set of remedies — and they’re doing this very intensely, of course,” said Dr. Oh, the Yonsei professor. “They are desperately searching for things to do to divert themselves from stress. They just don’t have a good model.”